Hawthorn announces affiliation with Steward

Hawthorn Medical Associates has announced a new affiliation with Steward Health Care System in a move that strengthens a major for-profit medical provider's footprint in SouthCoast.

ANIKA CLARK

DARTMOUTH — Hawthorn Medical Associates has announced a new affiliation with Steward Health Care System in a move that strengthens a major for-profit medical provider's footprint in SouthCoast.

With health care changing at the state and federal levels, "it was imperative that we positioned ourselves to be able to react to whatever comes out of those legislative bodies," said James Gularek, Hawthorn's executive director.

Since 1998, Hawthorn has been affiliated with Partners HealthCare, a Boston nonprofit. The move to the Boston-based Steward required a negotiated exit six years before the expiration of Hawthorn's agreement with Partners, according to Gularek. He said he will become Hawthorn's CEO when the deal goes into effect by the end of the calendar year.

Steward has a roster of 11 hospitals, including St. Anne's Hospital in Fall River.

Gularek said Hawthorn shareholders approved the 10-year-agreement with Steward and it was signed in June.

Hawthorn Medical Associates is a for-profit group that consists of two entities: Hawthorn Medical Associates LLC, which comprises about 80 doctors, plus nurse practitioners and physician assistants, and what is currently named Hawthorn Medical/Partners Community Healthcare Inc. This latter entity includes about 500 employees, ranging from X-ray technicians to receptionists and housekeeping staff.

Under the affiliation agreement, Hawthorn Medical/PCHI will become Hawthorn Medical Associates/Steward Medical Group and "all of the employees will be employed by Steward," Gularek said. Hawthorn buildings are owned by various real estate companies, but Gularek said Steward will own assets ranging from diagnostic equipment to furniture.

Hawthorn doctors will not be employed by Steward but will join the Steward Health Care Network, according to network president Dr. Mark Girard. He said the group already includes many providers from the region, and Steward negotiates insurance reimbursement rates for the network.

The affiliation deal "means that we're going to be able to better integrate care for the communities of New Bedford and Fall River, where Hawthorn and we practice," Girard said. "It's about becoming part of a community care model and being able to integrate care wherever it's been accessed."

Dr. Mitchell Glavin, an assistant professor at Stonehill College's department of health care administration, said by email that Steward's strategy of driving care to community hospitals instead of Boston academic medical centers fits well with the preference of many area doctors and patients. The Steward deal will help maintain medical services in SouthCoast, Glavin said, and may increase them.

Steward spokesman Christopher Murphy said the agreement will help Hawthorn move to a global payment model, which pays providers a fixed amount per patient over a certain period rather than by fee-for-service.

"An independent physician group can't absorb this kind of risk contract on its own because it doesn't have the scale required," Murphy said. "By joining with Steward, Hawthorn is now able to operate on the payment model of the future, and maintain ... the high quality of care that they deliver in affiliation with other doctors in the New Bedford-Fall River-Dartmouth area."

Steward accepts all major insurers, according to Murphy.

Dr. Alan Sager, professor of health policy and management at Boston University School of Public Health, said that if patients are able to continue their relationship with doctors they probably won't be immediately affected by the deal.

But "if Steward doesn't gain patients for Saint Anne's, why are they enticing Hawthorn away from its Partners affiliation?" he asked. He described increasing bargaining power with insurance companies as another potential motive.

Gularek said no facet of the affiliation agreement requires, affects or rewards referrals to a specific medical facility.

Patients should feel no impact of the shift, he said, other than perhaps seeing more services in additional locations.

A Partners spokesman said the system is disappointed to see Hawthorn go. "This is really the marketplace evolving and changing and this is just the latest chapter in that story," said spokesman Rich Copp.

Keith A. Hovan, president & CEO of Southcoast Health System and Southcoast Hospitals Group offered a prepared statement.

"We hope to have a continued collaborative relationship with Hawthorn Medical Associates, keeping the best interest of all patients and the community at the forefront, while continuing to provide the highest quality of care to the region," he said.

Gularek said Hawthorn will retain local control through an executive committee of physicians and himself.

Although Steward has conducted some layoffs at St. Anne's, there are "no plans to lay people off," Gularek said. "We're a very successful group and we plan on staying that way."